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Individual

RICHARD Q CALLAHAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MSPA, PA-C

Contact information

Practice address
111 COLCHESTER AVE, DERMATOLOGY - ACC/WP-5, BURLINGTON, VT 05401-1473
(802) 847-4570
(802) 847-3364
Mailing address
111 COLCHESTER AVE, DERMATOLOGY - ACC/WP-5, BURLINGTON, VT 05401-1473
(802) 847-4570
(802) 847-3364

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
055-0030786
VT
363AS0400X
Surgical Physician Assistant
055-0030786
VT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
055-0030786
LICENSE
VT
Enumeration date
10/24/2005
Last updated
11/12/2013
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